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Malignant-looking thyroid nodules with size reduction: core needle biopsy results
Ha Young Lee1,2, Jung Hwan Baek1, Eun Ju Ha1,3
1Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Purpose:
The aim of this study was to evaluate whether malignant-looking thyroid nodules with size reduction were malignant or not.
Methods:
From November 2010 to July 2011, we retrospectively enrolled 16 patients with 16 nodules (11 females and five males; mean age, 55 years) who underwent core needle biopsy (CNB), and whose thyroid nodules had malignant ultrasonographic (US) features, although they showed size reduction (>20% decrease in maximum diameter) during the follow-up period (mean, 37±27 months). The histologic findings of the CNB specimen were reviewed and correlated with the US findings. US studies were analyzed for their internal content, shape, margin, echogenicity, the presence of microcalcification and macrocalcification, inner isoechoic rim, and low-echoic halo.
Results:
All nodules were confirmed as benign by CNB. Pathologic analysis was available for 12 CNB specimens. US imaging showed central hypoechogenicity or marked hypoechogenicity in all cases and a peripheral isoechoic rim in 15 nodules. US-pathologic correlation showed that the central hypoechoic area was primarily composed of fibrosis (12/12) and hemorrhage (8/12) and that the isoechoic rim was composed of follicular cells.
Conclusion:
In our study, the CNB results of all of the malignant-looking thyroid nodules with size reduction were benign and were primarily composed of internal fibrosis and hemorrhage. Understanding these US and pathologic features could prevent repeated fine-needle aspiration or unnecessary diagnostic surgery.
Insights
Malignant-appearing thyroid nodules that shrink are typically benign, showing fibrosis and hemorrhage on biopsy. This understanding can help avoid unnecessary procedures.
Area of Science:
- Radiology
- Pathology
- Endocrinology
Background:
- Thyroid nodules with malignant ultrasonographic (US) features often raise concern.
- Size reduction in nodules can complicate diagnostic interpretation.
Purpose of the Study:
- To determine the malignancy status of thyroid nodules exhibiting malignant US features but demonstrating size reduction.
- To correlate US findings with histopathology in these specific nodules.
Main Methods:
- Retrospective analysis of 16 patients with thyroid nodules showing malignant US features and >20% size reduction.
- Core needle biopsy (CNB) performed on all nodules.
- Detailed analysis of US features including echogenicity, margin, calcifications, and rim characteristics.
- Histopathologic review of CNB specimens and correlation with US findings.
Main Results:
- All biopsied nodules were confirmed as benign.
- Common US findings included central hypoechogenicity and a peripheral isoechoic rim.
- Histopathology revealed fibrosis and hemorrhage in the hypoechoic areas and follicular cells in the isoechoic rim.
Conclusions:
- Thyroid nodules with malignant US features and size reduction are predominantly benign.
- Internal fibrosis and hemorrhage are key histopathologic findings.
- Recognizing these features can prevent unnecessary fine-needle aspiration or surgery.
